Dietary and Medical Interventions for Autism (Biomedical treatment, Autism 101)

Transcription

1 Dietary and Medical Interventions for Autism (Biomedical treatment, Autism 101) Julie A. Griffith, M.D., M.S., C.M.T. Pediatric and Adult Neurology Behavioral Neurology/Neuropsychiatry 120 Ross Valley Drive San Rafael, CA (415) March 15th, 2006 FEAT Sacramento

2 Autism-working model Genetic predisposition PLUS environmental triggers (toxins, infections, and allergic triggers which cause gut-brain-immune dysfunction)

3 Autism Language deficits Social pragmatic deficits Fine motor deficits Hypotonia Unusual behaviors

4 Cerebellar cognitive-affective syndrome. Schmahmann, ANPA conf ) Deficits with the following: Executive function Spatial cognition Language Affect -blunting or disinhibition

5 Language dysfunction Language delay- word deafness (not interpret word as having meaning initially), receptive language delay (not just delay, not acquire normal milestones of language, but also abnormal quality of speech and language). Speech-hypophonic, aprosodic (without melody) Often receptive language function>expressive language function (speech)

6 Social skill abnormalities Social pragmatic abnormalities Poor eye contact (eye fixation in autistics is at other s mouth) Dr. Joe Piven, University of North Carolina)

7 Fine motor difficulties weak grasp hypotonia of limbs (hands>feet), and axially (trunk) Dyspraxia Incoordination Writing deficits (graphomotor delay)

8 Underlying medical problems Nutritional deficiencies Immune dysregulation allergy infection inflammation Heavy metal toxicities

9 Nutritional deficiencies of the following amino acid Essential fatty acids B vitamins Minerals Zinc >lithium>magnesium= iron, >calcium Antioxidants, especially glutathione Nutrients of detoxification (cysteine, sulfate, and glutathione) Sometimes Vitamin A, C, E (especially gamma tocopherol)

10 Immune dysregulation Allergies (undigested food causing delayed hypersensitivities to food, but less frequently immediate allergies) Immunodeficiencies (secondary to nutritional deficiencies, also look for genetic causes) Chronic infection (viral, fungal, bacterial, parasitic) Neuroimmune -Majority of children

11 Toxicities-Heavy metal poisoning, sources 1. Thimerosol from vaccinations (Rhogam and influenza to mother), vaccinations to child 2. Dental amalgams 3. Fish (power plants, gold mining in CA) 4. Water (Arsenic, lead, mercury) 5. Food-aluminum and tin from cans

12 The Greater Sacramento Area has some degree of exposure to heavy metals arsenic (water), lead (pipes to homes, especially if older) mercury (from Gold mines during heavy rain runoff, accumulation in fish) Per NRDC (National Resources Defense Council), Lead in drinking water EPA website-multiple fish from different regions, including Bay Area, in which some fish have levels of mercury exceeding the safe limit (swordfish, etc)

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14 Sacramento, mercury 300 abandoned mercury mines and thousands of abandoned gold mines 26 million pounds of mercury used in gold ore recovering in No Calif Biggest mercury problems in Califronia at lakes, streams around old dams

15 Why treat? Autism is now treatable (has been for the past several years) Over 1000 documented cases of autism in which child is significantly improved or has recovered. See biochemical pathways involved in autism in handout See Parent Ratings of Behavioral Effects of Biomedical interventions (detox 76% better, nutritional supplements (30-63%), special diets (40-65%), food allergy Rx (61%)

16 Treatment I. Genomics-identify genetic predisposition of biochemical fragility II. Stop harmful environmental factors-toxins (heavy metals, drugs that challenge weak detoxification system, judicious use of antibioitics, and vaccinations) III. Restore nutrition regular and for biochemical individuality IV. Stop inflam., normalize immune funct - antiinflammatory diet, -remove triggers, allergens, infections, heavy metals V. Remove toxins (detoxification of heavy metals)

17 Treatment duration 10 months- 1 ½ yrs approx for general gutbrain-immune problems and detoxification Variability in genetics and environmental exposure may shorten or extend duration of Rx - metabolic disease - seizures -other brain injury low oxygen and low blood flow to brain brain trauma

18 Treatment team Parents Primary care provider, either is DAN! Physician or refers to one Nutritionist Sometimes allergist, gastrointestinal or immunologist/infectious disease consultant, neurologist or psychiatrist, osteopath if there is mechical injury Community (grandparents, teachers, therapists to observe changes, implement consistent teaching, provide educational and other therapies, ensure adherence to the diet, and to provide respite )

19 Parents-getting started 1. Read Children with Starving brains by Jacquelyn McCandless/educate self. Parents are the best advocate. 2. Attend next DAN! Conference, Apr 7 th, Wash. 3. Do from home before seeing physician 4. Consider obtaining nutritionist 5. Inform PMD want biomedical treatment 6. Obtain DAN! Physician a. Diagnostic testing/ b. Genomics c. Diet/nutritionally replete, d. B12 shots e. remove allergens, f. treating infection g. detoxify / h. Seizures?

20 I. Getting started from home A. Diet B. Epsom salt baths C. (HEPA filter if child has respir allergies) D. Judicious vaccination E. Breastfeed as long as possible F. Multivitamins/multiminerals G. probiotics H. Remove excessive stimuli in bedroom, in family room, diningroom I. If any speech delay, request audiogram and tympanogram (by primary care physician or audiologist)

21 Getting started from home- DIET- (30-65% efficacy on parent survey) Filter water-distilled or reverse osmosis Fresh, whole food, organic produce, home grown Glass, no tin or aluminum cans, try not to give leftovers (mold) Free range, grass fed animals, wild fish (not mercury laden) Pantry-throw out processed, dyed, foods (or give to charity) Antiinflammatory diet

22 Antiinflammatory diet Increase prostaglandin E 3 (omega 3, 6, 9 essential fatty acids Omega 3 (100 mg/kg) Nordic naturals proomega (concentrated, no heavy metals) (ensure no easy bruising or bleeding disorder) Omega 6 (nuts), omega 9 (olive oil) Also avocado, walnuts, grass fed animals Avoid: dairy, corn or grain fed animals

23 Diet, general principles: Plant based, 5-13 vegetables, rainbow of colors. Vegetables are yummy!! Protein (aa deficient), eat protein first No concentrated sweets Judicious use of starch carbohydrates (only with meals) Eat fruit with oil (ie fruit with nuts) fluid load in between meals, weighted towards am

24 Vegetarian- peril in autism Good=volume of vegetables is good Risky: amino acid deficiency essential fatty acid defic (source: algae) no vit B12 exacerbates methyl. defect (if prolonged, causes sensory neuropathy and blindness)

25 Gut disease Cause of gut disease: mercury, oral Abx bacteria, yeast overgrowth inflammation, food allergies, maldigestion, diarrhea, constipation Ileal lymphoid nodular hyperplasia, increased intestinal permeability, enzyme deficiencies Treat: remove offending foods that cannot be broken down (DIET), remove toxins, repair gut, reinnoculate with good bacteria (good flora) and critical nutrients

26 Special diets Gluten-free/Casein-free (GFCF) diet Specific Carbohydrate diet Finegold Diet (tolerable and sometimes intolerable sources of sulfur) These diets remove components that are thought to cause or contribute to ongoing problems contending with proteins and/or carbohydrates the gut cannot digest and absorb

27 Which diet? How start? Do general principles Depends on the child and the child s medical problems If know has food sensitivities, remove food to begin Test for food allergies (physician) Test for gut infections If severe or recalcitrant gut infections, begin specific carb0hydrate diet (especially with malabsorption( Leaky gut, across the board allergies) If zoned out staring, hand flapping, begin caseingluten free diet

28 Special diets: Casein-free Why do it: IgE (immediate) and IgG (delayed) hypersensitivity to casein. (blood test to Meridian labs, 179 foods nuts and spices) (DPPIV) Casein- caseomorphin-- amino acids (urine for caseomorphin testing) Great Plains I believe Doctor s Data and Great Smokies labs) (may need to give DPPIV enzyme alone or with enzymes) Effects seen in 1 wk If choose to eat any dairy, yogurt is the healthiest, goat products are often better tolerated Dairy free 4 months or until off of spectrum especially if see improvement ensure supplement with Vitamin D 3 (and sunlight, 10 minutes per day) and calcium. Can check strength of nails

29 Gluten Free diet Problems with gluten IgE and IgG reactions DPPIV ineffective in breaking down gluteomorphin (spaced out, high pain threshold) See effects from 1 wk up to 9 months later Gluten IgG can damage brain (Celiac disease, gluten causes occipital seizures) Harder to implement

30 Gluten and casein-free diet Macrobiotic diet (Japanese), very healthy

31 Yeast free diet Yes: meat, poultry, eggs, fresh nuts (not peanuts or pistacios), fresh fruit (2 /day, not moldy ones, grains brown rice, amaranth, buckwheat, corn water, juices (dilute with water or seltzer), fruit or vegetable Snacks popped corn in olive oil med high heat with brewer s yeast, celtic sea salt, organic butter or ghee

32 Yeast free diet Foods to avoid Sugar, honey, syrup, malt, fructose, corn syrup Fermented vinegar in foods (salad dressings, mustard, ketchup, mayo soy sauce, tofu Yeasty foods (beer, wine, bagels, bread) Moldy foods coffee tea Juices not freshly made

33 Specific carbohydrate diet Starves the bad bacteria and fungi from getting needed carbohydrates. Organisms die stop toxin damage to intestinal wall, microvilli carbohydrate enzymes recover, carbohydrate digestion and absorption improve, nutrition and health improves. Simple carbohydrates (not complex) are absorbed by child. (Only diet that targets malabsorption). Proper (able) absorption is restored Must read Breaking the Vicious Cycle by Elaine Gottschall to learn the stages of the diet.

34 Specific carbohydrate diet (SCD) Allowed: fresh/frozen meats, poultry, fish, vegetables, fruits, all raw nuts and nut butters without additives, vegetable juices, milkshakes with homemade yogurt, fruits/honey-sweetened

35 Specific carbohydrate diet Not Allowed Canned meats, vegetables, fruits Grains (no grains, flour, potatoes, bean) No dried fruit glazed with corn syrup or sugar, molasses, jellies Roasted nuts Milks: cow, goat, soy, rice, canned coconut

36 Benefits of SCD diet Alleviation of spaciness, generalized fatigue, muscle aches, stiff joints, arthritis, chronic skin rashes, psoriasis Healing the gut

37 Epsom salts Provides magnesium and sulfate 1 cup magnesium sulfate and 1 cup of sodium bicarbonate (increases solubility and absorption) before bedtime (magnesium causes hypotonia) Sulfate needed to produce the melatonin molecule 3-7 x/wk

38 Probiotics- good bacteria If chronic diarrhea, known systemic fungal infection (fungal infection in nails, red ring on skin, groin/buttock pinpoint red rash, athlete s foot, simmer s ear, chronic sinusitis Consider a) culturelle 30 billion lactobacillus acidophilus /capsule, 1 pill twice a day b) Klaire Ther Biotic detoxification support (Wellness or Needs pharmacy) 50 billion of bifidobacter and 2 other species)/capsule, 1 pill twice a day Foods: sauerkraut, kim che, cooked vegetables

39 Other measures for general health Breastfeed for as long as possible (watch mother s diet, ensure good dha intake) Good multivitamin and multimineral Thorne-Children s Basic Nutrients Douglas Metagenics chewable or liquid mycelized Integrative Therapeutics -child essence Cu free minerals for detox, children s chewables with Cu liquid mvi/mmi and liquid cal-mag Iron- get CBC diff plt, ferritin, serum iron, give iron if anemic Copper, measure blood level only minimal FDA amount to keep from

40 Other measures, general health, autism If speech delay, obtain audiogram and tympanogram from pediatrician s office or audiologist Remove excessive stimuli in bedroom, in family room, diningroom If chronic or intermittent nasal stuffiness/environmental allergens, get a HEPA filter for bedroom and family room

41 Other measures Judicious vaccinations a) start, when child well (no infection for past month) b) Vaccination needed? Hep B age 12, no rubella for boys, check titers first to see if deficient before revaccinating (esecially if in recovery period) c) Ensure no thimerosol (check bottle), if influenza, get thimerosol free d) one vaccine at a time, single dose vial without preservative e) If have immunodeficiency, test for abiilty to even mount immune response (IgG level)

42 Nutritional supplementation Not need DMG TMG blocks effect of methylb12, blocks progression (Neubrander, verbal communication March, 2006)

43 Prevention, next baby Have organic, whole foods prenatal vitamins B vitamins, Calcium, zinc, iron probiotics before conception Essential fatty acids (DHA) Avoid food sensitivites (gluten, casein) low carbohydrate diets mercury from fish and elsewhere Artificial sweetners MSG food dyes, toxins water filtration

44 Future topics Preparing for detoxification Metallothionein promoter, alliathiamine, DMSA topically (detoxification/chelation) The neurology or understanding of the nervous system involvement in autism Genomics-biochemical pathway, genetic mutations, and nutritional supplementation to amplify or drive the needed chemical pathways